Monday, August 25, 2014

Lactation Consultants are fairy godmothers devoted to mothers and babies, appearing out of nowhere at the crack of a broken nipple or the click of a bad latch, they sprinkling pixie dust upon mothers' nursing dreams. When they impart their wisdom, their words weave a whimsical spell, furnishing a happily ever after for mom and baby. [Insert the sound of vinyl being scratched].

Back in the real world, lactation consultants, like any professional, are not immune to incompetency. No doubt you’ve heard about LCs dishing out faulty advice to an unsuspecting mother, unwittingly sabotaging her breastfeeding efforts. Perhaps after a poke and a prod they diagnose that a mother's milk has ‘dried up’ when in fact it has just regulated; or perhaps they advocate the breast pump as a gage of how much milk a mother is producing. Maybe they suggest formula top-ups, test weighing, block feeding, controlled crying, et cetera; the list of potentially poisonous advice is endless. Could this explain why for every successful breastfeeding story, there are countless failures? Could some fairy godmothers be witches in disguise? One cannot escape the tragic irony that professionals employed for the sole purpose of facilitating breastfeeding, may actually be partaking in its demise.

Why are so many mothers being sabotaged by lactation consultants? Part of the answer lies in one simple fact:

There are two types of lactation consultant

Before I launch into my rant, I need you to read this short story; its relevance will become apparent, trust me:

After receiving the Nobel Prize for Physics in 1918, Max Planck went on tour across Germany. Wherever he was invited, he delivered the same lecture on new quantum mechanics. Over time, his chauffeur grew to know it by heart: “It has to be boring giving the same speech each time, Professor Planck. How about I do it for you in Munich? You can sit in the front row and wear my chauffeur’s cap. That’d give us both a bit of variety.” Planck liked the idea, so that evening the driver held a long lecture on quantum mechanics in front of a distinguished audience. Later, a physics professor stood up with a question. The driver recoiled: “Never would I have thought that someone from such an advanced city as Munich would ask such a simple question! My chauffeur will answer it!”

Okay, back to breastfeeding. There are two types of knowledge. First, we have real knowledge. We see it in people who have committed a large amount of time and effort to understanding a topic. The second type is what I am going to call chauffeur knowledge - knowledge from people who have learned to put on a show. Maybe they have a white coat, brandish leaflets, even hold a certificate, but the knowledge they espouse is not their own. They are adhering to a scripted 'medical model' of breastfeeding. They reel off eloquent and technical words as if reading from a script. They are on thin ice, and they know it.

The Medical Model of Breastfeeding Advocacy

Unfortunately for the exhausted and, dare I say, vulnerable new mother, it is difficult to distinguish whether a lactation consultant’s advice derives from real knowledge or from medical model - chauffer - knowledge. A major problem with the dominance of the medical model in defining and dealing with breastfeeding problems is that it carries with it implicit assumptions and explicit practices that isolate the innate physiological characteristics of breastfeeding and pathologize them. Normal breastfeeding behaviour is framed as something to be 'worked out' and 'gotten over' like recovery from an acute illness. Yet many breastfeeding 'problems', such as cluster feeding, have no cure, because they are normal healthy biological processes. This situation is exacerbated by the pertinent issue of misdiagnosis.

Let me tell you about a fascinating, if horrific, phenomenon that has been documented in medical research: Patients who are told they have a pathological condition, for instance high blood pressure, immediately begin to experience more illness-related absenteeism from work, though their physiological condition had not changed from previous months or years - they had simply been labelled as sick. Likewise, when mothers are misdiagnosed as having poor milk supply, many behave in a way coherent with this diagnosis, becoming apathetic and debilitated, behaviour which, in turn, leads to genuine low supply. Dayyyyum!

Another problem with the medical model is that it requires the mother to be passive. It assumes an expert professional serving an inexpert patient and thus relies on a hierarchical relationship based on the former's textbook chauffer knowledge. It focuses on atomized mothers and babies, often placing them in a clinical setting, and then separates them from their social, cultural, and historic contexts. When viewed out of context in this way, mothers' social locations and cultural understandings fade out of view. Professionals, placed in the driving seat, draw upon their chauffer knowledge to access and make sense of the symptoms of a passive mother-baby dyad. What I'm saying is that in the medical model, definitions of what constitute a breastfeeding problem flow from the professional's assumptions and stock knowledge and are imposed on the mother and baby's experience rather than being constructed from it.

Indeed, LC's solutions to problems are frequently narrow medical treatments, for instance drug prescriptions, nipple shields, or more commonly, formula top-ups. It continues to astonish me the respect and trust these perfectly-coiffed script readers enjoy, not to mention the fact that they earn a salary delivering support on a topic some of them can barely fathom. Here is some actual advice given by lactation consultants to new mothers (click to read the details in full):

This list is, of course, anecdotal, and thus only scrapes the surface of global maternal experience. It is however clear from such accounts that many LCs are arguably well-intentioned yet ultimately fail because they have only a limited textbook ‘circle of competence’. They rely solely on their chauffeur knowledge. What lies inside this circle they understand; what lies outside, they may only partially comprehend. When faced with an issue outside the perimeters of their competence, say, helping a sick or severely premature baby to latch, they find their script is lacking and so bluff their way through. For instance, the difference between a baby feeding effectively at the breast and one who is struggling to get milk is obvious - if you know what to look for. However, many lactation consultants with chauffer knowledge don't realise that breastfeeding is different from bottle feeding. So, when they see a baby 'sucking strongly' (usually with his lips pursed and cheeks drawn in), they assume he is feeding effectively. They couldn't be more wrong. Unfortunately, because the medical model of breastfeeding is the dominant go-to paradigm, it informs the view of most lay people. Everyday people often join the professional in seeing any hitch in the breastfeeding journey as analogous to an illness.

So, is there still a place for LCs in our health care system? I'd say certainly, but within narrowly prescribed limits. Rather than being insidious witches in disguise, many current LCs are merely out of their depth, often being devoid of the practical acumen that comes with having breastfed a baby oneself. How can mothers distinguish LCs with chauffer knowledge from those with real knowledge? (And more importantly, should mothers be burdened with this task?) A good way for moms to increase their chances of obtaining genuine quality of care, is to opt for the services of a breastfeeding peer supporter (as an extra bonus, they're normally free).

Whilst a LC is apt to apply a fatalistic 'diagnosis' and 'treat' medical-model approach to the breastfeeding journey, a peer supporter - because she has 'been there' herself - is more likely to adopt a practical needs-based 'manage', 'adapt', 'adjust' and 'cope' approach. By the very nature of being a literal peer, she is inclined towards self-empowerment: a non-hierarchal shift from the medical model of 'power over the mother' to having 'power with the mother'. In a nutshell, what I'm advocating here is mothers working with mothers. The Experienced guiding the Novice. In turn, the Novice herself becomes experienced, and passes that wisdom down to another Novice. This is oldschool stuff my friends, and it works.

Monday, August 18, 2014

Did you know can educate, entertain and exercise your child using just a single pipe cleaner? Oh yes you can! A pipe cleaner is the perfect toy for children of all ages! Don't believe me? Here's 100 reasons why..

Use your pipe cleaner as a 'tickle stick' to tickle your baby's feet. For toddlers you can introduce body-part language by tickling different parts and naming them.

2. Zipper Pull:

Toddlers often have problems with their zipper until they develop the fine motor skills. Help your toddler by attaching your pipe cleaner to their zipper. It gives them extra leverage and looks pretty neat too.

Kids' shoes are always coming unlaced. Not if they are made of pipe cleaners! Your pipe cleaner will also be easier for your child to manipulate with their little fingers, making learning to tie shoe laces a doddle!

Create a finger puppet and then act out a story. When the story's over, unroll your finger puppet and create a different character for a new story! Don't worry if you don't have the equipment to add details (eyes, nose) - your child's imagination is the best equipment.

How many words to describe the pipe cleaner can you child name? Furry, Light, Thin, Red, Glitter, Soft, Toy, Stripey, etc. When you feel they are getting stuck, prompt them with various concepts such as length (long, short) or dexterity (flexible, bendy, twisty).

30. Length Lingo:

Take the above activity to the next level with this game. Give your kiddo a pipe cleaner and ask them to make it 'Shorter' (they could bend it in half). Now ask them to make it 'Longer', then 'Shortest', etc. If you have any hair clips to hand you could use it to mark various lengths on the pipe cleaner (see pic below).

Encourage your child to converse with this simple activity. Explain to your child that whoever is holding the pipe cleaner is the only person who can speak. Ask your child a simple question such as "What did you do that was fun today?" Hand the pipe cleaner to your child and encourage him/her to respond. Continue to converse using the pipe cleaner. Variations: This is a great activity to use at dinnertime to keep your child's attention on the conversation. Hold the pipe cleaner and begin telling a story, passing the pipe cleaner to another family member to continue the story. Continue passing the pipe cleaner until the story is finished! Be ready for some interesting twists in the plot!

Here's a math activity with a twist (quite literally!) Twist your pipe cleaner into a spider or an octopus and ask 'how many legs'. Can your child create more legs, less legs. Take a leg away by rolling it up - how many left?

47. Cameleon Game:

Discuss cameleons and how they use their skin as camouflage. Create a pip cleaner cameleon with your child and then find an environment for your cameleon to 'blend in'. If your pipe cleaner is green, the garden would be a perfect spot. Of course, your cameleon doesn't have to look as fancy as this fella:

Use the pipe cleaner as a horizontal line, keep your feet behind the line, and see how far in front of the line you can place your foot, using only one hand to balance yourself.

53. Tricky Tweezers:

Bend the pipe cleaner to make tweezers and then challenge your child to pick up small, light items. Great for fine motor skills but takes skill to avoid bending the pipe cleaners when attempting to pick up the item.

54. Measuring:

Have your child lay on the floor and then use the pipe cleaner to 'measure' how many pipe cleaners' tall she is.

55. Barbie Coat Hanger:

Twist your pipe cleaner into a cute miniature coat hanger for Barbie's ever-expending wardrobe. Yep, I know, Barbie is evil, so you could always pretend this mini coat hanger is for 'the faries' or something.

56. Barbie Bling:

Use your pipe cleaner to bling up your Barbie (or anyone else if you're a Barbie-hater). Challenge your child to find as many creative ways to pimp up their toys as possible.

Fine tune your preschooler's fine motor skills by inviting them to explore the concept of balancing. First, twist the pipe cleaner into a semi-circle and then challenge your child to 'hang' the pipe cleaner from various locations (this is a lot harder than it looks and requires uber concentration!)

Use the pipe cleaner as a conductor's baton and invite your child to sing (when you wave the baton high, they must sing high notes; when you wave it low, they must sing low notes). Now switch roles so your child can be the conductor.

69. Musical Notes:

Carry on with the music theme by using your pipe cleaner to construct musical notes. Now see if you can label them - e.g. Treble clef; Quarter note; Beamed note (see the full range here).

Bend the pipe cleaner to symbolise clock hands and take turns making and guessing what the time shown is.

71. Core Workout:

Laying on your back hold the pipe cleaner between your feet. Keep your legs straight and raise them up and pass the pipe cleaner to your hands. Drop your feet back down slowly, then back up, passing the pipe cleaner back to your feet. Continue for 15 repetitions.

72. Stretch:

Sit with feet straight out in front of you and with the pipe cleaner in your hands above your head reach down and stretch as far as you can towards your feet. Put the pipe cleaner down. Reach back up to the top and back down to pick up the pipe cleaner again. Repeat.

73. Sitting Bunny:

Follow the step-by-step instructions to create a cute little bunny, perfect for Easter.

Challenge your child to twist their pip cleaner into various speech bubble shapes, and then invite them to place their speech bubble over a word in the environment (on the page of a book, a sign, a newspaper, etc).

75. Star of David:

Try your hand at creating the Star of David, a Jewish religious symbol. Once made (if you ever get the thing made - it's difficult!) ask your child how many triangles they can identify. Look for big triangles and small triangles.

You need a group of kiddos for this game. First, one player begins with the pip cleaner. The other children close their eyes or leave the room while he hides the pipe cleaner and then sits down. Next, the other children return to the room and begin hunting for it. The twist is that they must hunt with their eyes only - no moving around the room allowed - since the pipe cleaner is partially visible. The first player to spot the pipe cleaner sits down on the floor. In this way, the finger avoids letting the other players know where it is. One by one, as the other players see the pipe cleaner, they sit down. When all the players are sitting down (or after a period of a few minutes), the first one who saw the pipe cleaner whispers the whereabouts to the hider. If the hider confirms that the first spotter has found the pipe cleaner, the pipe cleaner is retreived from its hiding place and the first spotter takes a turn as the hider.

..Notice something? You've just inadvertently encouraged your kids to be quiet and sit still. Genius! (Don't say I never gave you anything).

This is another hunting game, so a group of kiddos is required. All players except one sit in a circle. The remaining player, who is the hunter, sits in the middle of the circle. The hunter closes her eyes and slowly counts to ten out loud. Meanwhile, the other players begin passing the pipe cleaner around the circle, keeping it hidden in their hands (you may have to curl it up). When she reaches ten, the hunter opens her eyes and - while the pipe cleaner is still being passed - tries to figure out who has it.

Once your child and their buddies are old enough to control the volume of their voices and keep a secret, they are sure to love this game of mischievous whispers. To play, participants sit in a circle on the floor. One player is chosen to start, and it is his job to come up with (but not say loud) a brief message. "I'm wearing blue underwear" is a good 'un. Whatever the message, the first player holds the pipe cleaner like a telephone and leans over whispering it into the ear of the player to her right. The player then passes the pipe cleaner and whispers the message to the player on his right, and so on until the message makes its way back to the first player.

A topsy tail tool is a very helpful object for making specific hairstyles. It helps you in flipping your hair or in pulling it through something like a braid or ponytail to create a new style. Twist your pipe cleaner as show to create a topsy tail that your child can use on their hair to create a multitude of styles!

Explore the mathematical concept of angles with your child. Twist the pipe cleaner to show an angle, for example, 90 degrees, and invite your child to guess the angle. Alternate this activity by saying a number, and inviting your child to twist the pipe cleaner to demonstrate that angle.

92. Drink Charm:

Need wine or drink charms in a pinch so your guests don't mix up their glasses? Don't dash off to the store in a last minute attempt to stock up on charms; simply grab some pipe cleaners from your craft box and get your kid to fashion a few!

Give yourself comedy hair, just be sure to remove before you step into public.

95. Hair Curler:

Okay, this one is more strategic than the above. Twist damp hair around a pipe cleaner and leave to dry. You'll end up with perm-style curls.

96. Pipe Cleaner Name:

Using a super-long pipe cleaner, challenge your child to create their entire name. This activity mirrors handwriting. The finished item is ideal for labelling personal belongings or using as a bedroom door sign!

Twist your pipe cleaner in half, then curl over the ends to make a nifty stand for your cellphone or tablet (image below shows paper clip but this activity actually works better with a pipe cleaner!)

98. To Infinity:

The concept of infinity is difficult for even adult to completely understand, but your teen should be old enough now to grasp the basics. Twist your pipe cleaner into the official 'infinity symbol' (below). Explain that infinity is an abstract concept describing something without any limit. Why does your teen think this symbol represents infinity? What things can your teen name that have no beginning and no end? (e.g. a circle).

99. Pipe Cleaner Sandals:

You'll need an extra-long pipe cleaner for these bad boys (or a few regular pipe cleaners will do). Invite your teen to design their own high fashion sandals. For sure, they ain't functional but Tyra Banks would be all over them.